# NORTHEWESTERN OPTHALMIC INSTITUTE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881754570
- **Authorized official:** DR. THOMAS E BOURNIAS (DR)
- **Authorized official phone:** (847) 832-3900

## Contact information

- **Practice address:** 3633 WEST LAKE AVENUE, SUITE 104, GLENVIEW, IL 60026
- **Practice address phone:** (847) 832-3900
- **Practice address fax:** (847) 832-3904
- **Mailing address:** 3633 WEST LAKE AVENUE, SUITE 104, GLENVIEW, IL 60026
- **Mailing address phone:** (847) 832-3900
- **Mailing address fax:** (847) 832-3904

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 36093343 | IL | Yes |

## Other

- **Enumeration date:** 12/11/2006
- **Last updated:** 03/15/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036093343 | — | IL |
| 01 | — | 7797487 | AETNA | IL |